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1
Mencer, Nicholas, Larry Todd Justice, William Black, and Kayleigh Litton. "A Rare Case of Takotsubo Syndrome and Acute Coronary Syndrome of the Right Coronary Artery." Case Reports in Cardiology 2019 (June 9, 2019): 1–4. http://dx.doi.org/10.1155/2019/9128273.
Повний текст джерелаАнотація:
Takotsubo syndrome (TTS) is an increasingly recognized heart disease that was initially regarded as a benign condition, but since has proven to cause irreversible myocardial damage, resembling that of acute coronary syndrome (ACS). The etiology of TTS is still uncertain but may be associated with catecholamine elevations during times of emotional or physical stress. Catecholamines are also understood to have prothrombotic properties, which could lead to ACS. With these similarities, differentiating these two pathologies can be difficult, especially when TTS and ACS occur simultaneously.
2
Ognjenović, Areta. "Nursing interventions in the treatment of syndrome Takotsubo // Zadaci kardiološke medicinske sestre u lečenju Takotsubo sindroma." SESTRINSKI ŽURNAL 5, no. 1 (November 28, 2018): 45. http://dx.doi.org/10.7251/sez0118045o.
Повний текст джерелаАнотація:
Takostube syndrome (TS; broken heart syndrome) is described as transient reversible cardiomyopathy that occurs in older women in most cases as a result of mental or psychological suffering. It is associated with various disorders and it is defined as Takotsubo Syndrome (TS). The clinical picture is similar to acute coronary syndrome, but it must differ from acute ischemic heart disease. Ethiopathological factors have not been fully clarified, but the main role in the development of TS by catecholamine-induced spiking myocardial capillaries or the direct toxicity of catecholamines themselves.There are no strict guidelines in the implementation of health care for patients with TS. Given the great similarity in the clinical picture between acute myocardial infarction and TS, the same procedures and tasks are used in practice as in patients with acute myocardial infarction with ST elevation, while coronarography does not prove to be the opposite. The patient under suspicion of diagnosis of TS is admitted to the coronary unit.Healthcare goals for the treatment of patients with TS are identical to those in acute coronary syndrome and include: pain relief, tension reduction - anxiety, preservation of myocardial function, and prevention and treatment of complications.
3
Andronic, Gheorghe, Oana-Petronela Oancea, Alexandru-Dan Costache, Ovidiu Mitu, and Florin Mitu. "Takotsubo Syndrome." Internal Medicine 19, no. 3 (September 1, 2022): 61–67. http://dx.doi.org/10.2478/inmed-2022-0220.
Повний текст джерелаАнотація:
Abstract Takotsubo syndrome occurs in 1-2% of patients admitted in the emergency department with suspicion of ST-segment elevation myocardial infarction (STEMI), over 90% being postmenopause women. Psycho-emotional or physical stress is the main trigger that causes the release of catecholamines, with an important role in the pathophysiology of Takotsubo cardiomyopathy. In most cases, supportive and symptomatic treatment is sufficient, with a dynamic follow-up of the left ventricular (LV) function. Usually, a complete recovery occurs in 3-4 weeks. We are presenting the case of a 67-year-old patient with a severe angina attack which occuredafter a major psycho-emotional stress, with an electrocardiographic appearance of an anterior STEMI and echocardiographic apical ballooning, both compatible with Takotsubo syndrome. Coronary angiography showed a muscle bridge with a systolic compression of 75% on the anterior descending artery (ADA). The evolution was marked by the occurrence of cardiogenic shock remitted under treatment, with complete recovery of LV systolic function. The particularity of the case resides in an acute coronary syndrome (ACS) after a psycho-emotional stress associated with a muscular bridge, as well as the appearance of the cardiogenic shock.
4
Demea, Anca Diana, Dan-Grigore Dunca, Roxana Adina Radu, and Lucia Agoșton-Coldea. "TAKOTSUBO SYNDROME INDUCED BY MALIGNANT PHEOCHROMOCYTOMA IN A PATIENT WITH TYPE 2 PAPILLARY RENAL CELL CARCINOMA – A CASE REPORT." Medicine and Pharmacy Reports 91, no. 2 (April 26, 2018): 242–44. http://dx.doi.org/10.15386/cjmed-920.
Повний текст джерелаАнотація:
The clinical presentation of the Takotsubo syndrome mimics an acute coronary syndrome with chest pain, ischemia-like ECG changes, mild to moderate myocardial enzyme elevation, and apical ballooning on echocardiography and ventriculography. On coronary angiography, epicardial coronary arteries are either normal or exhibit minimal atherosclerotic changes. Primary Takotsubo syndrome usually occurs in postmenopausal women in whom symptoms are triggered by emotional or physical stress, associated with catecholamine surges. Secondary Takotsubo syndrome may have multiple causes, including an increased catecholamine release due to pheochromocytoma.We present the case of a 56-years-old woman with confirmed Takotsubo syndrome who was later diagnosed with pheochromocytoma and type 2 papillary renal cell carcinoma.
5
Fan, Xuehui, Guoqiang Yang, Jacqueline Kowitz, Ibrahim Akin, Xiaobo Zhou, and Ibrahim El-Battrawy. "Takotsubo Syndrome: Translational Implications and Pathomechanisms." International Journal of Molecular Sciences 23, no. 4 (February 10, 2022): 1951. http://dx.doi.org/10.3390/ijms23041951.
Повний текст джерелаАнотація:
Takotsubo syndrome (TTS) is identified as an acute severe ventricular systolic dysfunction, which is usually characterized by reversible and transient akinesia of walls of the ventricle in the absence of a significant obstructive coronary artery disease (CAD). Patients present with chest pain, ST-segment elevation or ischemia signs on ECG and increased troponin, similar to myocardial infarction. Currently, the known mechanisms associated with the development of TTS include elevated levels of circulating plasma catecholamines and their metabolites, coronary microvascular dysfunction, sympathetic hyperexcitability, inflammation, estrogen deficiency, spasm of the epicardial coronary vessels, genetic predisposition and thyroidal dysfunction. However, the real etiologic link remains unclear and seems to be multifactorial. Currently, the elusive pathogenesis of TTS and the lack of optimal treatment leads to the necessity of the application of experimental models or platforms for studying TTS. Excessive catecholamines can cause weakened ventricular wall motion at the apex and increased basal motion due to the apicobasal adrenoceptor gradient. The use of beta-blockers does not seem to impact the outcome of TTS patients, suggesting that signaling other than the beta-adrenoceptor-associated pathway is also involved and that the pathogenesis may be more complex than it was expected. Herein, we review the pathophysiological mechanisms related to TTS; preclinical TTS models and platforms such as animal models, human-induced pluripotent stem cell-derived cardiomyocyte (hiPSC-CM) models and their usefulness for TTS studies, including exploring and improving the understanding of the pathomechanism of the disease. This might be helpful to provide novel insights on the exact pathophysiological mechanisms and may offer more information for experimental and clinical research on TTS.
6
Zerhoudi, R., I. Essaket, K. Bourzeg, A. Zbitou, and A. Bouzerda. "Apical Ballooning Syndrome: A Cardiac Syndrome Mimicking Acute Myocardial Infarction." Scholars Journal of Medical Case Reports 10, no. 10 (October 4, 2022): 999–1006. http://dx.doi.org/10.36347/sjmcr.2022.v10i10.003.
Повний текст джерелаАнотація:
Introduction: Apical ballooning syndrome, Takotsubo cardiomyopathy, or broken heart syndrome, is a rare but currently well recognized clinical entity. It occurs after severe emotional or physical stress, most often in postmenopausal women, and mimics the symptoms and signs of acute coronary syndrome, in the absence of significant coronary injury. This cardiomyopathy is rapidly and completely reversible. The exact pathophysiological mechanism of the condition remains debated; several hypotheses have been put forward, the most credible of which seems to be a sudden hyperadrenergic reaction related to stress. Objective: To report the case of a patient with clinical features of possible myocardial infarction but diagnosed as Takotsubo cardiomyopathy. Case Report: The patient was a 64-year-old woman with no cardiovascular risk factors other than age and menopause, and no particular pathological history. She was admitted on Day 3 with infarct-like chest pain, which appeared following an episode of emotional stress, associated with NYHA stage III dyspnea. On admission, the patient was pain free. The clinical examination found a conscious patient, hemodynamically and respiratory stable, apyretic. The cardiovascular examination was unremarkable. The ECG was in sinus rhythm, showing a QS aspect in the anterosepto-apical area associated with negative T waves in the inferolateral area. The biological workup showed an inflammatory syndrome, with positive troponin at 650ng/l. The thoracic echocardiography showed an aspect of hypokinetic cardiopathy at the dilated stage with severe LV dysfunction (LVEF at 38%), a thin and flexible mitral valve with restriction of the small mitral valve with moderate mitral insufficiency (SOR at 20 cm2 and RV at 19 ml), a dilated left atrium. Coronary angiography showed angiographically healthy coronary arteries, and an MRI was performed, confirming the diagnosis of Takutsbo cardiomyopathy. Discussion and Conclusion: Takotsubo cardiomyopathy is an increasingly recognized clinical entity, characterized by apical left ventricular dysfunction with chest pain, electrocardiographic changes, minimal biomarker changes, and no coronary lesions. In most cases, an episode of emotional or physical stress precedes the event. Its pathophysiological mechanism remains unknown, but high circulating catecholamines seem to be the triggering factor and the most plausible explanation for this primary acquired cardiomyopathy. It is important to be aware of this diagnosis in patients presenting with ACS because its evolution is most often spontaneously favorable.
7
Shilova, A. S., A. O. Shmotkina, A. A. Yafarova, and M. Yu Gilyarov. "Takotsubo Syndrome: Contemporary Views on the Pathogenesis, Prevalence and Prognosis." Rational Pharmacotherapy in Cardiology 14, no. 4 (September 4, 2018): 598–604. http://dx.doi.org/10.20996/1819-6446-2018-14-4-598-604.
Повний текст джерелаАнотація:
Takotsubo syndrome (TTS) is a reversible left ventricular dysfunction characterized by local apical hypokinesia usually triggered by a physical or emotional stress. According to the last available data TTS may represent 2% of all admissions for acute coronary syndromes. Despite the reliable prevalence, diagnosis of TTS remains difficult. The initial presentation, both clinically and electrocardiographically, is similar to an acute myocardial infarction (AMI). The biomarker profile is also similar, although the peaks of troponin and creatinine kinase levels are lower, and brain natriuretic peptide levels are higher in patients with TTS compared with ST-segment elevation AMI. Modified Mayo diagnostic criteria are the most common for the diagnosis. Pathogenesis of TTS currently is not well understood. Catecholamines appear to play a central role in the pathophysiology of TTS. However, it is conceivable that some people have a genetic predisposition to stress-induced TTS. A genetic predisposition has been suggested based on the few familial TTS cases described. Despite reversible myocardial dysfunction, acute heart failure is the most common complication in the acute phase of TTS. In-hospital mortality rate is comparable to that of ST-segment elevation AMI. There are no randomized clinical trials to support specific treatment recommendations in TTS. It is believed that the tactics of managing patients with TTS hospitalized with suspicion of acute coronary syndrome should comply with the protocol of management of patients with AMI while acute coronary pathology is not excluded.
8
Sachdev, Esha, C. Noel Bairey Merz, and Puja K. Mehta. "Takotsubo Cardiomyopathy." European Cardiology Review 10, no. 1 (2015): 25. http://dx.doi.org/10.15420/ecr.2015.10.01.25.
Повний текст джерелаАнотація:
Takotsubo cardiomyopathy (TTC) is an acute, stress-induced cardiomyopathy with an increased prevalence in post-menopausal women. The syndrome is most frequently precipitated by an acute emotional or physical stressor and mimics acute myocardial infarction with symptoms, electrocardiogram (ECG) changes and cardiac troponin elevation that are indistinguishable from those caused by plaque rupture or coronary thrombosis. Diagnosis of TTC is made when coronary angiography reveals no obstructive coronary artery disease and the left ventricle demonstrates apical ballooning and basal hypercontractility. Other ventricular patterns have also been described. An abnormal myocardial response to the catecholamine surge from an emotional or a physical stressor is implicated in the pathophysiology, but the reasons for the high prevalence of TTC presentations in post-menopausal women are unknown. Several mechanisms including multi-vessel coronary vasospasm, endothelial and coronary microvascular dysfunction and direct catecholamine toxicity have been proposed. No specific guidelines for treatment of TTC have been established, but treatment is based on the American Heart Association/ American College of Cardiology guidelines for acute coronary syndrome/acute myocardial infarction and heart failure guidelines. In this review article, we discuss the characteristic clinical presentation of TTC and the commonly proposed mechanisms.
9
Younger, Holly. "A review of Takotsubo (broken-heart) syndrome." British Journal of Cardiac Nursing 15, no. 12 (December 2, 2020): 1–6. http://dx.doi.org/10.12968/bjca.2020.0095.
Повний текст джерелаАнотація:
Background/aims Approximately 2500 people each year in the UK are affected by Takotsubo syndrome. The syndrome is linked to stress and has a higher incidence in women. With a growing population, the number of cases is set to rise. This article examines risk factors and possible causes of Takotsubo syndrome, such as transient ischaemia, catecholamine levels, oestrogen levels and coronary artery spasm. Issues around accurate diagnosis and treatment options are also discussed. Methods A literature review was carried out using online databases such as CINAHL and BNI, incorporating international journals from the year 2000 onwards, to give a broad spectrum of information. Results It is clear from the literature review that Takotsubo syndrome is still widely misunderstood, which can lead to misdiagnosis and incorrect treatment. There are many theories as to the cause of Takotsubo syndrome, but no definitive answer. Conclusions Further research around Takotsubo syndrome is needed to minimise misdiagnosis. Further studies into ECG and troponin changes associated with Takotsubo syndrome may make it possible for Takotsubo syndrome to be diagnosed on admission and not mistaken for acute coronary syndrome.
10
Sheppard, Mary N. "Takotsubo Syndrome — Stress-induced Heart Failure Syndrome." European Cardiology Review 10, no. 2 (2015): 83. http://dx.doi.org/10.15420/ecr.2015.10.2.83.
Повний текст джерелаАнотація:
Takotsubo syndrome has been established as an entity in the past 30 years, particularly with the introduction of interventional angiography for investigation of chest pain. Typically, it occurs in middle-aged females as a response to a stressful event, such as bad news, death, accident, natural disaster, etc. but there is not always a specific trigger. Takotsubo mimics acute myocardial infarction with electrocardiogram changes and elevated troponins. On interventional angiography the coronary arteries are normal with typical apical ballooning of the left ventricle. This feature led to its descriptive name, given by Japanese cardiologists, as the left ventricle resembles a lobster trap with a narrow neck extending into a round ventricle. This leads to a reduction in cardiac function. Takotsubo is believed to be a response to catecholamine release following a stressful event resulting in temporary myocardial damage. It usually has a benign course with spontaneous return of cardiac function. However it may recur and in a small percentage of patients can result in sudden cardiac death with arrhythmia, acute myocardial infarction and cardiac rupture. It is usually treated symptomatically depending on the severity of presentation.
11
Jarosz, Dominika, Aleksandra Grudzińska, Paulina Dudzińska, Małgorzata Milanowska, and Hanna Tsitko. "Takotsubo cardiomyopathy – review of current literature." Journal of Education, Health and Sport 12, no. 12 (December 18, 2022): 286–90. http://dx.doi.org/10.12775/jehs.2022.12.12.043.
Повний текст джерелаАнотація:
Takotsubo syndrome (TTS) also known as broken heart syndrome is acute cardiac disease, which is characterized by reversible ventricular motion abnormalities, in the absence of justifying coronary artery disease. The clinical entity was first described in Japan in 1991. The word “Takotsubo” is a container used by the Japanese to catch octopus, which has a narrow neck and a relatively wide base, which resembles the heart's shape in TTS. The cardiomiopathy predominantly affects postmenopausal women and is often preceded by emotional (death of close family member, domestic abuse) or physical (external injury, severe pain) stress. The exact pathophysiological mechanism has not yet been fully clarified. Inordinate amount of catecholamines released into bloodstream after stress attack plays a crucial role in the pathogenesis of TTS. Symptoms of Takotsubo cardiomyopathy such as chest pain and dyspnea are similar to acute myocardial infarction due to it TTS requires careful diagnosis. The main tools for making diagnosis are echocardiography, coronary angiography, ECG, cardiac biomarkers and cardiac magnetic resonance. The syndrome is usually reversible, nevertheless number of patients may develop complications such as cardiogenic shock, arrhythmias, heart failure. Treatment is mostly supportive including Angiotensin-converting enzyme (ACEi) inhibitors and angiotensin receptor blockers (ARBs), which may reduce the likelihood of recurrent episodes. Generally patients with TSS have favourable prognosis, although some deaths are reported. This article is a review of current medical knowledge about Takotsubo syndrome based on available publications in Pubmed and Google Scholar databases.
12
Rawish, Elias, Thomas Stiermaier, Francesco Santoro, Natale Brunetti, and Ingo Eitel. "Current Knowledge and Future Challenges in Takotsubo Syndrome: Part 1—Pathophysiology and Diagnosis." Journal of Clinical Medicine 10, no. 3 (January 28, 2021): 479. http://dx.doi.org/10.3390/jcm10030479.
Повний текст джерелаАнотація:
First recognized in 1990, takotsubo syndrome (TTS) constitutes an acute cardiac condition that mimics acute myocardial infarction commonly in the absence of obstructive coronary artery disease; it is characterized by temporary left ventricular dysfunction, regularly in a circumferential apical, midventricular, or basal distribution. Considering its acute clinical presentation, coronary angiography with left ventriculography constitutes the gold standard diagnostic tool to exclude or confirm TTS. Frequently, TTS is related to severe emotional or physical stress and a subsequent increased adrenergic stimulation affecting cardiac function. Beyond clinical presentation, epidemiology, and novel diagnostic biomarkers, this review draws attention to potential pathophysiological mechanisms for the observed reversible myocardial dysfunction such as sympathetic overdrive-mediated multi-vessel epicardial spasms, microvascular dysfunction, the direct toxicity of catecholamines, lipotoxicity, and inflammation. Considering the long-term prognosis, further experimental and clinical research is indispensable to elucidate further pathophysiological mechanisms underlying TTS before randomized control trials with evidence-based therapeutic management can be performed.
13
Matveeva, Marina G., G. E. Gogin, and M. N. Alekhin. "Takotsubo cardiomyopathy: case report." Clinical Medicine (Russian Journal) 95, no. 7 (August 4, 2017): 663–68. http://dx.doi.org/10.18821/0023-2149-2017-95-7-663-668.
Повний текст джерелаАнотація:
This article reports a clinical case of Takotsubo cardiomyopathy manifest clinically, biochemicaly, electrocardiographically, and echocardiographicalyas acute myocardial infarction. The diagnosis was based on finding intact coronary arteries and rapid positive dynamics of instrumental and laboratory data. Takotsubo cardiomyopathy (CMP) (stress-associated CMP, apical ballooning syndrome) is a rare reversible disease developing after acute emotional and physical stress. Its prevalence is estimated at 1-2% of all cases of acute myocardial infarction. It most commonly affects postmenopausal women. The clinical picture is similar to that of acute coronary syndrome with transient hypo- and akinesiaof apical and middle segments of the left ventricle (LV) in combination with hyperkinesia of its basal myocardial segment in the absence of stenosis or a spasm of coronary arteries. The precise pathophysiology of the disease is unknown; several hypotheses are proposed including enhancedsympathoadrenal activity, catecholamine multivesselepicardial coronary artery spasm, coronary microvascular dysfunction, catecholamine cardiotoxicity and catecholamine-mediated myocardial stunning. The Mayo Clinic diagnostic criteria are most widely used in clinical practice: transient hypokinesia, akinesia, or dyskinesia of left ventricular mid-segments with or without apical involvement; regional wall motion abnormalities extending beyond the region of blood supply of a single epicardialartery; a stressful event oftenbut not always present in the medical history in the absence of obstructive coronary disease or angiographic evidence of acute plaque rupture; new electrocardiographic abnormalities (either ST-segment elevation and/or T-wave inversion) or modest elevation in cardiac troponin 1 level; the absence of pheochromocytoma and myocarditis. Takotsubo cardiomyopathyhas been classified into 3 types based on the involvement of the left ventricle: classical type, reverse type and mid-ventricular type; lesions of right ventricle are also described. Specific treatment of the disease is unavailable, and the main purpose of therapy is normalization of LV systolic function. The prognosis of Takotsubo cardiomyopathyis favorable, complete clinical recovery is observed in 95,5% of the cases, the average time of recovery is between 2 and 3 weeks.
14
Lin, Weiqin, Sen Hee Tay, and Anselm Mak. "Takotsubo syndrome and rheumatic diseases—a critical systematic review." Rheumatology 60, no. 1 (October 16, 2020): 11–22. http://dx.doi.org/10.1093/rheumatology/keaa504.
Повний текст джерелаАнотація:
Abstract Since its description in 1990, Takotsubo syndrome (TTS), an acute cardiac condition triggered by physical or emotional stress, has been believed to be related to catecholamine surge from overwhelming sympathetic activity. While symptomatology, biochemical features, ECG and echocardiogram alterations are largely indistinguishable from acute coronary syndrome, the absence of culprit coronary lesions often necessitates further investigations, uncovering underlying inflammatory processes. Mechanistically, animal models of TTS reveal early neutrophil infiltration followed by staged ingression of two subtypes of macrophages (M1, M2) mediating initial acute inflammatory changes (M1), followed by switching to anti-inflammatory signals (M2) that enhance myocardial tissue recovery. Here, we begin with a description of two TTS patients with primary Sjögren’s syndrome and Takayasu’s arteritis, followed by a systematic literature review that summarizes the demographic and clinical features of TTS patients with rheumatological conditions. Potential impact of disease manifestations and treatment of rheumatological conditions on TTS are critically discussed.
15
Putnikovic, Biljana, Vojkan Cvorovic, Milos Panic, Predrag Milicevic, Gordana Vojinovic-Maglic, and Aleksandar Neskovic. "Takotsubo cardiomyopathy: Report of the first case series in Serbia and review of the literature." Medical review 63, no. 1-2 (2010): 75–81. http://dx.doi.org/10.2298/mpns1002075p.
Повний текст джерелаАнотація:
Introduction. Takotsubo cardiomyopathy is a relatively novel cardiac syndrome that is characterized by transient left ventricular asynergy involving apical and mid-ventricular segments. Epidemiology and pathophisiology. It occurs predominantly in elderly women in the absence of obstructive coronary artery disease and is usually associated with severe emotional or physical stress. This syndrome is manifested with chest pain, electrocardiographic changes that mimic acute myocardial infarction, and minimal myocardial enzy?matic release. Several different mechanisms have been proposed: coronary artery spasm, dynamic left ventricular outflow/intracavitary obstruction, coronary microvascular dysfunction and direct catecholamine-mediated cardiomyocite injury. Therapy and prognosis. Complete recovery usually occurs after dramatic presentation, frequently complicated with acute heart failure. Therapy is empiric and directed towards supportive measures against cardiogenic shock, acute heart failure, dysrhythmias. In-hospital mortality rate is less than 1%, but long-term prognosis is still unknown. In addition to the review of the literature on takotsubo cardiomyopathy, we present the first series of patients with this syndrome detected in Clinical Hospital Center Zemun.
16
Vučić, Domagoj, Blaženka Miškić, Ninoslav Leko, Marijana Knežević Praveček, Krešimir Gabaldo, Katica Cvitkušić Lukenda, and Zvonimir Bosnić. "Pathophysiological association of catecholamine stress in a patient with Takotsubo cardiomyopathy and chronic kidney disease." Medicina Fluminensis 57, no. 2 (June 1, 2021): 209–14. http://dx.doi.org/10.21860/medflum2021_371659.
Повний текст джерелаАнотація:
Aim: Takotsubo cardiomyopathy is a transient dysfunction of the heart muscle that occurs in response to a stressful event. A working diagnosis is mostly made for acute ischemic heart disease due to similar clinical presentation and differential diagnostic doubts. Although it is a reversible disorder of cardiac contractility, mortality rate is similar to that of an acute coronary syndrome due to the development of complications. We report the case of a patient with chronic kidney disease and the consequent development of Takotsubo cardiomyopathy, a possible pathophysiological link that has not been reported in the significant number in literature so far. Case report: An 83-year-old patient on a chronic hemodialysis program, due to the development of anginal symptoms specific for the acute coronary syndrome and with a significant increase in cardiospecific enzymes, was transferred to the Coronary care unit for the necessary invasive cardiac treatment. Echocardiographic and coronarographic findings confirmed the diagnosis of Takotsubo cardiomyopathy, which was the first case in a patient on chronic hemodialysis program in our institution. Conslusions: According to available data, about 30 cases of Takotsubo cardiomyopathy have been reported so far, indicating that transient myocardial dysfunction is a rare cardiomyopathy in patients with chronic kidney disease. A small number of literature-recorded cases do not support the similar pathophysiological basis of increased sympathetic activity present in Takotsubo cardiomyopathy and chronic kidney disease.
17
Y-Hassan, Shams, and Henrik Falhammar. "Cardiovascular Manifestations and Complications of Pheochromocytomas and Paragangliomas." Journal of Clinical Medicine 9, no. 8 (July 30, 2020): 2435. http://dx.doi.org/10.3390/jcm9082435.
Повний текст джерелаАнотація:
Pheochromocytomas and paragangliomas (PPGLs) are rare neuro-endocrine tumors. The catecholamine surge causes paroxysmal or chronic secondary hypertension. PPGLs may present as hypertensive- or PPGL-crisis with severe life-threatening cardiac and cerebrovascular complications. PPGLs-induced cardiac manifestations have been reported with diagnoses as PPGLs-induced electrocardiogram (ECG) changes “mimicking acute myocardial infarction”, arrhythmias, myocarditis, acute coronary syndrome, dilated cardiomyopathy, and lately as takotsubo syndrome. Critical analysis of these reports reveals that most of these cardiac manifestations have certain features in common. They have a dramatic clinical presentation and are reversible if the disease is treated with appropriate medical therapy and surgical resection of the PPGL tumor. They may have the same repolarization ECG changes irrespective of the clinical cardiac diagnosis, usually associated with mild to moderate elevations of myocardial biomarkers as troponins and normal coronary arteries. The histopathological findings are usually focal or multifocal in the form hypercontracted sarcomeres and contraction band necrosis (myofibrillar degeneration) with subsequent secondary mononuclear cell infiltration. Evidences argue the PPGL caused surge of catecholamines triggers hyperactivation of the sympathetic nervous system with cardiac sympathetic nerve terminal disruption with norepinephrine spillover causing the cardiac complications. A comprehensive review of various reported cardiovascular manifestations and complications of PPGLs are presented.
18
Keshtkar, F., O. T. Dale, W. O. Bennett, and C. E. Hall. "Management of airway obstruction with nebulised adrenaline resulting in takotsubo cardiomyopathy: case report." Journal of Laryngology & Otology 130, no. 9 (July 5, 2016): 883–86. http://dx.doi.org/10.1017/s0022215116008288.
Повний текст джерелаАнотація:
AbstractBackground:Takotsubo cardiomyopathy has been associated with the use of catecholamines; however, its development after the use of nebulised adrenaline for the management of acute airway obstruction has not previously been described.Case report:A 66-year-old man with squamous cell carcinoma of the larynx, with tumour–node–metastasis staging of T3N2cM0, confirmed by biopsy and computed tomography, presented to the emergency department with acute airway obstruction. He was treated twice with nebulised adrenaline and intravenous dexamethasone. After a period of 24 hours, cardiac rhythm changes were noted on telemetry. A 12-lead electrocardiogram showed widespread T-wave inversion and QT prolongation suggestive of an acute coronary syndrome. Coronary angiography demonstrated no coronary artery disease, but left ventricular angiography showed marked apical ballooning and apical wall akinesia consistent with a diagnosis of takotsubo cardiomyopathy.Conclusion:Takotsubo cardiomyopathy can mimic true ischaemic heart disease and the diagnosis requires a high index of suspicion in patients managed with nebulised adrenaline.
19
Bounhoure, J. P. "Takotsubo or Stress Cardiomyopathy." Cardiovascular Psychiatry and Neurology 2012 (September 28, 2012): 1–4. http://dx.doi.org/10.1155/2012/637672.
Повний текст джерелаАнотація:
Many case reports have been published of reversible left ventricular dysfunction precipitated by sudden emotional stress. We have evaluated 10 women hospitalized for acute chest pain and dyspnea, mimicking an acute coronary syndrome, after a severe emotional trigger. Those patients, postmenopausal women, presented ST segment alterations on the EKG, minor elevations of cardiac enzymes, and biomarkers levels. At the coronarography there was not coronary thrombosis or severe stenosis, but the ventriculography showed wall motion abnormalities involving the left ventricular apex and midventricle, in the absence of significant obstructive coronary disease. The course was benign without complication, with a full recovery of left ventricular function in some weeks. These observations, like other reports, demonstrate the impact of emotional stress on left ventricular function and the risk of cardiovascular disease. The cause of this cardiomyopathy is still unknown, and several mechanisms have been proposed: catecholamine myocardial damage, microvascular spasm, or neural mediated myocardial stunning.
20
Assad, Joseph, Giuseppe Femia, Patrick Pender, Tamer Badie, and Rohan Rajaratnam. "Takotsubo Syndrome: A Review of Presentation, Diagnosis and Management." Clinical Medicine Insights: Cardiology 16 (January 2022): 117954682110657. http://dx.doi.org/10.1177/11795468211065782.
Повний текст джерелаАнотація:
Takotsubo Syndrome (TTS) is a condition of transient left ventricular dysfunction that is typically triggered by emotional or physical stress. Since first described in Japan in 1990, it has increasingly been recognised in clinical practice, accounting for up to 2% of Acute Coronary Syndrome (ACS) presentations. In fact, the clinical presentation can be indistinguishable from a myocardial infarction. Although current evidence suggests a catecholamine induced myocardial stunning, the pathophysiological mechanisms remain unknown. Interestingly, it is more common in woman, particularly those who are post-menopausal. This review aims to summarise the current research and provide an overview of the diagnostic strategies and treatment options.
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Smyrlis, Athanasios, Dmitry Yaranov, Ira Galin, Shahzad Khan, and Jonathan Alexander. "Recurrent Direct Current Cardioversion Induced Takotsubo Cardiomyopathy." International Cardiovascular Forum Journal 3 (September 3, 2015): 32. http://dx.doi.org/10.17987/icfj.v3i0.94.
Повний текст джерелаАнотація:
<p>Stress cardiomyopathy (SCM), also called broken heart syndrome and Takotsubo cardiomyopathy is an increasingly reported syndrome generally characterized by transient systolic dysfunction of the apical and or mid segments of the left ventricle that mimics myocardial infarction, in the absence of obstructive coronary artery disease. Typically patients present within a few hours of exposure to physical or emotional stress. However, the mechanism by which these stressors result in myocardial dysfunction is unclear. Proposed factors include catecholamine excess and coronary vasospasm<sup>1</sup>. We present the case of a 61-year-old female who experienced acute pulmonary edema secondary to stress cardiomyopathy, on two occasions immediately after undergoing elective direct current cardioversion (DCCV) for atrial fibrillation (Afib). After an urgent hospitalization for management of acute left ventricular failure, she made a complete clinical and echocardiographic recovery. The incidence, clinical implications and prognosis of DCCV induced SCM is unknown. Given DCCV for Afib is a common outpatient procedure and DCCV induced SCM can lead to acute clinical deterioration it is important that physicians are vigilant about this newly recognized electrical cardioversion complication.</p>
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Singh, Trisha, Hilal Khan, David T. Gamble, Caroline Scally, David E. Newby, and Dana Dawson. "Takotsubo Syndrome: Pathophysiology, Emerging Concepts, and Clinical Implications." Circulation 145, no. 13 (March 29, 2022): 1002–19. http://dx.doi.org/10.1161/circulationaha.121.055854.
Повний текст джерелаАнотація:
Takotsubo syndrome is a condition characterized by acute transient left ventricular systolic dysfunction, which at presentation can be challenging to distinguish from acute myocardial infarction. Although previously thought to be a benign, self-limiting condition, recent studies have confirmed that patients with takotsubo syndrome have persistent subtle ongoing cardiac dysfunction, and many continue to have limiting symptoms despite restoration of left ventricular ejection fraction. Moreover, these patients have a substantial burden of morbidity and mortality, as well, with high rates of subsequent major adverse cardiovascular events that approach those of patients with acute coronary syndrome. The mechanisms behind this condition remain elusive. Despite substantial research, the medical community continues to have an incomplete understanding of its underlying pathogenesis and pathophysiology. Catecholamine-induced myocardial injury is the most established and well-known theory, but this does not explain all the clinical features and presentations of the condition, and numerous other pathways and abnormalities are emerging. Because of the poor understanding of its underlying pathophysiology, there is a lack of evidence-based interventions to treat the acute episode, to avoid recurrences, and to prevent major adverse cardiovascular events. This highlights the need for further research to gain a better understanding of the underlying pathophysiology to inform appropriate randomized controlled trials of interventions targeting the causative pathways. Only then can evidence-based management strategies be established to improve clinical outcomes of this potentially lethal condition.
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Maes, Sebastiaan, Nicolas Simon James Jeremy Dhooghe, Henri Schotte, Steffi Cattoir, Tom Frans Jacobs, and Koenraad Van Landuyt. "Takotsubo Cardiomyopathy Induced by Epinephrine Infiltration for Liposuction: Broken Heart Syndrome." Aesthetic Surgery Journal 39, no. 10 (August 28, 2019): NP431—NP436. http://dx.doi.org/10.1093/asj/sjz201.
Повний текст джерелаАнотація:
Abstract Broken heart syndrome, more commonly known as Takotsubo cardiomyopathy (TCM), is an acute cardiac condition. It is characterized by regional cardiac wall motion abnormalities triggered by physical or emotional stress or administration of catecholamines such as epinephrine. The initial clinical presentation is similar to an acute coronary syndrome and must be ruled out. Visualization of the characteristic wall motion will trigger the diagnosis of TCM. In this case report, we present a 50-year-old woman with additional liposuction and fat grafting after autologous breast reconstruction. Shortly after infiltration with a solution containing epinephrine to achieve vasoconstriction, hypotension and bradycardia was noticed. This escalated into full asystole for which cardiac resuscitation was required. ST-elevations and a decrease in systolic function were clear indicators for urgent coronarography and ventriculography. These confirmed the diagnosis of TCM. Infiltration with epinephrine-containing products to achieve local vasoconstriction is used routinely. Medical professionals should be aware that this can trigger a TCM with an estimated mortality rate of 5%. No evidence of a specific preventive measure currently exists. We know that women with a neurologic or psychiatric comorbidity and high levels of stress are more at risk. Reducing stress and anxiolytic medication prior to surgery could be useful. We also know that the cardiac wall motion abnormality is mainly related to β-adrenoreceptors. The use of a selective α-adrenoreceptor agonist could be considered. Further research in the pathophysiology and incidence of TCM could improve identification of patients at risk and lead to more effective prevention and treatment. Level of Evidence: 5
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Sethi, Yashendra, Hamsa Murli, Oroshay Kaiwan, Vidhi Vora, Pratik Agarwal, Hitesh Chopra, Inderbir Padda, Manasa Kanithi, Mihaela Simona Popoviciu, and Simona Cavalu. "Broken Heart Syndrome: Evolving Molecular Mechanisms and Principles of Management." Journal of Clinical Medicine 12, no. 1 (December 24, 2022): 125. http://dx.doi.org/10.3390/jcm12010125.
Повний текст джерелаАнотація:
Broken Heart Syndrome, also known as Takotsubo Syndrome (TS), is sudden and transient dysfunction of the left and/or right ventricle which often mimics Acute Coronary Syndrome (ACS). Japan was the first country to describe this syndrome in the 1990s, and since then it has received a lot of attention from researchers all around the world. Although TS was once thought to be a harmless condition, recent evidence suggests that it may be linked to serious complications and mortality on par with Acute Coronary Syndrome (ACS). The understanding of TS has evolved over the past few years. However, its exact etiology is still poorly understood. It can be classified into two main types: Primary and Secondary TS. Primary TS occurs when the symptoms of myocardial damage, which is typically preceded by emotional stress, are the reason for hospitalization. Secondary TS is seen in patients hospitalized for some other medical, surgical, obstetric, anesthetic, or psychiatric conditions, and the dysfunction develops as a secondary complication due to the activation of the sympathetic nervous system and the release of catecholamines. The etiopathogenesis is now proposed to include adrenergic hormones/stress, decreased estrogen levels, altered microcirculation, endothelial dysfunction, altered inflammatory response via cardiac macrophages, and disturbances in the brain-heart axis. The role of genetics in disease progression is becoming the focus of several upcoming studies. This review focuses on potential pathophysiological mechanisms for reversible myocardial dysfunction observed in TS, and comprehensively describes its epidemiology, clinical presentation, novel diagnostic biomarkers, and evolving principles of management. We advocate for more research into molecular mechanisms and promote the application of current evidence for precise individualized treatment.
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Wang, Xiaopu, Junyu Pei, and Xinqun Hu. "The Brain-Heart Connection in Takotsubo Syndrome: The Central Nervous System, Sympathetic Nervous System, and Catecholamine Overload." Cardiology Research and Practice 2020 (March 9, 2020): 1–5. http://dx.doi.org/10.1155/2020/4150291.
Повний текст джерелаАнотація:
Takotsubo syndrome (TTS), also known as stress cardiomyopathy, is a type of acute heart failure syndrome triggered by intense psychological or physiological stress. TTS typically manifests as acute chest pain, dyspnea or syncope that mimics an acute myocardial infarction but does not involve coronary artery obstruction. The current understanding of the pathogenesis of TTS suggests that sympathetic nervous system (SNS) activation plays a central role. Specifically, stress can activate the SNS and lead to the over-release of catecholamine, which have toxic effects on myocardial tissue when present at excessive levels. However, the brain changes associated with TTS and the connection between the brain and the heart in patients with this disease remain unclear. In recent years, several published reports have revealed the role of this brain-heart connection in the pathogenesis of TTS. This review summarizes recent studies regarding SNS activation, catecholamine overload, and the brain-heart connection in patients with TTS from both pathophysiological and mechanistic aspects.
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Badami, Krishna G. "Post-Transfusion Takotsubo Cardiomyopathy." Blood 138, Supplement 1 (November 5, 2021): 4280. http://dx.doi.org/10.1182/blood-2021-151775.
Повний текст джерелаАнотація:
Abstract In three recent cases an initial transfusion-related adverse event (TRAE) occurred that had a significant respiratory component, and other features suggesting a severe allergic reaction. All were treated as such. Shortly after treatment the nature of the event changed to something resembling transfusion-associated circulatory overload (TACO). These cases suggest the possibility that a severe TRAE that is not TACO may precipitate TACO. In other words, some transfusions, sometimes, may deliver a 'double whammy'. A possible mechanism might be through the development of Takotsubo, or stress, cardiomyopathy - a cause of acute, reversible, heart failure. Takotsubo cardiomyopathy typically presents with chest pain or shortness of breath. Ventricular wall dysfunction occurs, and characteristic echocardiographic abnormalities are seen. ECG and biochemical features suggest cardiac ischaemia. It is commoner in post-menopausal women. A range of 'stressors' - hypotension, asthma attacks, accidents, medical procedures, pain, bad news, etc. - may precipitate it. 1 Catecholamines such as adrenaline are believed to play a central role. They cause direct toxicity to the myocardium, and also coronary artery spasm, and increased cardiac workload. 2 One other such case is reported. There, a 48 years old post-menopausal woman developed acute reversible heart failure with the features of Takotsubo cardiomyopathy, following urticaria and pruritus, whilst having a platelet transfusion. No adrenaline was given, but the authors postulate that adrenergic and histaminergic elements may have combined to produce the effect on the heart. 3 Thus, in some patients the 'perfect storm' compounded of borderline cardiac function,catecholamine release (secondary to the stress of the underlying disorder, the transfusion, and the TRAE),histamine release (in allergic TRAE),the treatment of the allergic reaction with adrenalinerecent or ongoing volume overload may be sufficient to precipitate or exacerbate TACO. Careful consideration of cases with similar features is needed. Potential precipitating factors are modifiable or preventable. References: 1. https://www.health.harvard.edu/heart-health/takotsubo-cardiomyopathy-broken-heart-syndrome 2. https://www.ahajournals.org/doi/full/10.1161/CIRCULATIONAHA.116.027121 3. Zhou JQ, Choe E, Ang L, et al. Stress-induced cardiomyopathy associated with a transfusion reaction: A case of potential crosstalk between the histaminic and adrenergic systems. Exp Clin Cardiol.2011; 16: 30-32 Figure 1 Figure 1. Disclosures No relevant conflicts of interest to declare.
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Covell, Dustin, and Nathan Clendenen. "Transient Left Ventricular Apical Ballooning in a Postmenopausal Woman with Chronic Liver Disease, Malignancy, and Recent Ischemic Stroke: A Case Report and Review of the Literature." ISRN Vascular Medicine 2012 (November 25, 2012): 1–6. http://dx.doi.org/10.5402/2012/478536.
Повний текст джерелаАнотація:
Transient left ventricular apical ballooning (TLVAB), or Takotsubo cardiomyopathy, is a poorly understood phenomenon that is thought to be related to a surge of catecholamines under stress conditions that causes microvascular dysfunction and a unique pattern of myocardial stunning. TLVAB occurs in two distinct patient populations: (i) community presentation similar to acute coronary syndrome and (ii) the critically ill. Understanding the differences in presentation, prognosis and management between these two groups may improve the outcome. We present a case of TLVAB developing in a Caucasian postmenopausal female who developed TLVAB suddenly on a background of chronic liver disease, malignancy, and recent ischemic stroke. The patient presented with hemodynamic collapse and was treated with inotropes, vasopressors, and supportive care until cardiac function improved. Additionally, we review the current literature describing the risk factors, pathophysiology, and treatment of TLVAB.
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Марушко, А. В., Я. Ю. Джунь, Г. Б. Маньковский, Е. Ю. Марушко та С. А. Кузьменко. "Сlinical Case of Diagnosis and Treatment of a Patient with Takotsubo Cardiomyopathy". Кардиология в Беларуси, № 1 (19 березня 2021): 128–34. http://dx.doi.org/10.34883/pi.2021.13.1.011.
Повний текст джерелаАнотація:
Введение. Кардиомиопатия такоцубо (КМПТ), или синдром такоцубо, или стрессиндуцированная кардиомиопатия, – это синдром, который клинически имитирует острый коронарный синдром, однако, в отличие от последнего, патогенетически возникает вследствие повышенной чувствительности рецепторов определенных участков миокарда к действию катехоламинов. Распространенность данного заболевания, согласно документу международного экспертного консенсуса, составляет 1–3% из всех заподозренных ОКС. Однако в Украине КМПТ диагностируют крайне редко.Цель. Проанализировать случай синдрома такоцубо и оценить особенности диагностики и лечения пациентов с данной патологией.Материалы и методы. В работе представлены клинический случай кардиомиопатии такоцубо, результаты инструментальных методов исследования, выбор тактики лечения и контроль отдаленных результатов терапии.Результаты. На базе ГУ «НПМЦ ДКК МЗ Украины» в ургентном порядке в катетеризационную лабораторию поступила женщина 69 лет с предварительным диагнозом: острый не-Q-инфаркт миокарда передне-перегородочно-верхушечной области левого желудочка (ЛЖ), ранняя постинфарктная стенокардия с формированием аневризмы верхушки ЛЖ и наличием пристеночного тромба в апикальной области. При поступлении были проведены: электрокардиография (ЭКГ), эхокардиография (ЭхоКГ), коронаро- и вентрикулография ЛЖ. На основе данных анамнеза, жалоб и результатов инструментальных и лабораторных исследований был поставлен диагноз «кардиомиопатия такоцубо», избрана консервативная тактика лечения. Уже на третий день после госпитализации у пациентки наблюдалась положительная динамика по сократимости ЛЖ, в день выписки (14-е сутки от начала симптомов) – полное восстановление функции ЛЖ и уменьшение размеров тромба по данным ЭхоКГ.Заключение. Кардиомиопатия такоцубо имитирует острый инфаркт миокарда и должна лечиться в соответствии с протоколом ГКС до момента исключения гемодинамически значимых поражений коронарных артерий. В катамнезе данных пациентов происходит спонтанное полное восстановление сократимости миокарда ЛЖ. Поэтому проведение дифференциальной диагностики ГКС с кардиомиопатией такоцубо требует настороженности врачей по поводу последней. Introduction. Takotsubo cardiomyopathy (CMPT), or Takotsubo syndrome, or “stress-induced cardiomyopathy” is a syndrome that clinically and instrumentally mimics acute coronary syndrome (ACS), but it is pathogenetically due to the increased sensitivity of myocardial receptors catecholamines. The prevalence of this disease, according to an international expert consensus document, is 1–3% of all suspected ACS. However, in Ukraine, CMPT is diagnosed very rarely.Purpose. To evaluate the case of Takotsubo syndrome and estimate the features of diagnosis and treatment of patients with this pathology.Materials and methods. This article presents a clinical case of Takotsubo cardiomyopathy, the results of instrumental research methods, the choice of treatment tactics, and control of the long- term outcome of therapy.Results. A woman of 69 years old with a previous diagnosis of acute non-Q-myocardial infarction of the anterior-septal-apical part of the left ventricle, early post-infarction angina pectoris with the formation of an aneurysm with parietal thrombus in the apical area. On admission, the ECG, echocardiography, LV coronary angiography, and ventriculography were performed. On the base of the anamnesis, complaints, and results of instrumental and laboratory studies, the Takotsubo cardiomyopathy was diagnosed and conservative treatment was chosen. On the third day after hospitalization, the patient had positive tendency of LV contractility; on the day of discharge (14th day from the onset of symptoms) – complete recovery of LV function and reduction of thrombus size according to echocardiography.Conclusion. Takotsubo cardiomyopathy is the diagnosis of exclusion in patients with suspected acute myocardial infarction. Therefore, doctors’ awareness of this pathology plays an important role at all stages of treatment of such patients.
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Vanni, Domitilla, Nicola Viceconte, Greta Petrella, Flavio Giuseppe Biccirè, Francesco Pelliccia, Gaetano Tanzilli, and Daniel Oscar Cicero. "A Pilot Study on the 1H-NMR Serum Metabolic Profile of Takotsubo Patients Reveals Systemic Response to Oxidative Stress." Antioxidants 10, no. 12 (December 13, 2021): 1982. http://dx.doi.org/10.3390/antiox10121982.
Повний текст джерелаАнотація:
Takotsubo syndrome (TTS) presents as an acute coronary syndrome characterized by severe left ventricular (LV) dysfunction and non-obstructive coronary artery disease that typically shows spontaneous recovery within days or weeks. The mechanisms behind TTS are mainly related to beta-adrenergic overstimulation and acute endogenous catecholamine surge, both of which could increase oxidative status that may induce further deterioration of cardiac function. Although several studies reported evidence of inflammation and oxidative stress overload in myocardial tissue of TTS models, systemic biochemical evidence of augmented oxidant activity in patients with TTS is lacking. In this study, serum samples of ten TTS patients and ten controls have been analyzed using 1H-NMR spectroscopy. The results of this pilot study show a marked alteration in the systemic metabolic profile of TTS patients, mainly characterized by significant elevation of ketone bodies, 2-hydroxybutyrate, acetyl-L-carnitine, and glutamate levels, in contrast with a decrease of several amino acid levels. The overall metabolic fingerprint reflects a systemic response to oxidative stress caused by the stressor that triggered the syndrome’s onset.
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Katz, Matthew, Stephen Walsh, Benjamin Tsang, Pamela McCombe, and Arman Sabet. "059 Takotsubo cardiomyopathy and myasthenic crises: a case series." Journal of Neurology, Neurosurgery & Psychiatry 90, e7 (July 2019): A19.2—A19. http://dx.doi.org/10.1136/jnnp-2019-anzan.51.
Повний текст джерелаАнотація:
IntroductionTakotsubo cardiomyopathy (TCM) is an acute, reversible cardiomyopathy that can mimic acute coronary syndrome.1 It is characterised by left ventricular dysfunction, electrocardiogram (ECG) changes and transient apical ballooning in the absence of significant coronary artery disease.1 It is usually triggered by acute stress with catecholamine surge but the exact pathogenesis is not known.1 Takotsubo cardiomyopathy has been described in patients with myasthenic crisis. We present the first and largest case series of four patients with TCM in the setting of myasthenic crisis and discuss possible causes.MethodsTwo patients from each tertiary neurologic centre were identified by their treating neurologist for inclusion in the series. We performed a review of their case notes with respect to history, examination, investigations and management. A brief literature review was also completed.ResultsThe mean age was 78 with a 1:1 female to male ratio. Three of the patients were newly diagnosed with myasthenia gravis (MG) at the time of their TCM. All patients were AChRab positive. One patient had a previous thymectomy but the others had no evidence of thymoma.On review of the literature most cases of TCM in myasthenic crisis occurred in older females. Abnormalities of the ECG were universal. Most cases did not have a thymoma or history of thymectomy.ConclusionTakotsubo cardiomyopathy may be easily overlooked in those presenting with myasthenic crises as they share overlapping clinical features. Rigorous attention to the cardiac status of these patients, especially the ECG, may help to avoid missing this important diagnosis.ReferenceAkashi YJ, Goldstein DS, Barbaro G, Ueyama T. Takotsubo cardiomyopathy: a new form of acute, reversible heart failure. Circulation 2008;118:2754–2762.
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Castillo, Stalin Bismarck, Daniela Alejandra Pozo, Cecibel Estefanía Villacís, and María José Portero. "SÍNDROME DE TAKOTSUBO Y ESTRÉS AGUDO." Revista Medica Vozandes 32, no. 1 (July 6, 2021): s17—s18. http://dx.doi.org/10.48018/rmv.v32.i1.s9.
Повний текст джерелаАнотація:
Introduction Takotsubo Syndrome (STk) is characterized by a transient systolic regional dysfunction on the left ventricle, usually diagnosed in 2% of the patients presenting with clinical suspicion of ST elevating myocardial infarction (STAMI). Main etiology is still unclear, correlating with pericardial artery spasm, microvascular alterations, viral myocarditis, heightened catecholamine levels with alteration of sympathetic system, and anatomical variations of the anterior descendent artery. Several emotional and physical triggers are linked to its development, but symptoms can arise in their absence. Most common signs and symptoms include: acute chest pain, dyspnea and syncope, initially indistinct to those of an acute myocardial infarction. Its presence varies according to the trigger: on those with a strong emotional trigger chest pain and palpitations, while on physical stress, underlying disease predominates (stroke, seizure). Case description A 58 year old female, without medical history of cardiovascular disease, was admitted to the hospital because of left sided chest pain, beginning 2 hours ago, most likely caused by emotional distress. On arrival, initial diagnosis was Acute Coronary Disorder (ACD). Coronarography, and anterior oblique right ventriculography confirming the diagnosis. Requiring mainly low-molecular-weight heparin anticoagulation during admission and novel anticoagulants for outpatient care, added to anxiety treatment. Follow-up started October 2019 and went on during 2020. Conclusion STk has similar characteristics to those of ACD on postmenopausal women. The present Clinical Case meets 3 of the 4 Mayo Criteria, and has 61 points on the InterTak score. Acute chest pain, dyspnea and syncope plus several additional studies can confirm STk. EKG showing ST elevation (90%), negative T wave on precordial leads (44%), Q wave present (15-27%). Elevation of the ST segment on V4 to V6 is higher than V1 to V3, with absence of Q anomaly. Heightened troponin levels, but lower than AMI; Heghtened BPN or proBPN could be present. Myocardial stunning could be liked to catecholamine levels 2 to 3 times higher than AMI with Killip III. The recovery does not require treatment, but could require diuretics, beta blockers, ACEs, angiotensin-II receptor blockers, statins and acetylsalicylic acid. Prognosis is favorable with mortality under the 2%.
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Azmath, Misbah, Snigdha Bendaram, Yuichi Igarashi, Hassaan Aftab, and Carl Malchoff. "PSAT006 Two Cases of Pheochromocytoma Associated Takotsubo Syndrome- Importance of Early Recognition and Treatment." Journal of the Endocrine Society 6, Supplement_1 (November 1, 2022): A88—A89. http://dx.doi.org/10.1210/jendso/bvac150.182.
Повний текст джерелаАнотація:
Abstract Introduction Pheochromocytoma is a rare catecholamine producing adrenal medullary tumor that classically presents with hypertension. Takutsubo cardiomyopathy (TC) is a rare but increasingly recognized presentation of pheochromocytoma. We present two cases of TC likely caused by pheochromocytoma. Case 1 A 60 y/o male who presented with acute onset nausea, vomiting and abdominal pain. Systolic BP was 150-160 mm Hg, and diastolic BP was 100 mmHg. Troponin was elevated (4.15 ng/ml; nl = 0-0.04). An echocardiogram showed a reduced left ventricular ejection fraction (LVEF) of 15-20% (nl = 50-75%), a mildly dilated left ventricle, and apical ballooning suggestive of TC. Coronary arteries were normal on cardiac catheterization. CT scan identified a 5.3×5.6×5.7 cm adrenal mass of 50 HU pre-contrast. Further evaluation revealed markedly elevated plasma metanephrine concentration of 858 pg/ml (nl<57) and normetanpehrine concentration of 1729 pg/ml (<148). His presentation was strongly suggestive of pheochromocytoma associated TC. He was prepared for surgery with doxazosin 2 mg twice daily followed by metoprolol succinate and metyrosine up to 500 mg/d. Final pathology revealed a 5.3 cm left pheochromocytoma with negative surgical margins. Germline genetic testing was negative for pheochromocytoma/paraganglioma pathogenic gene mutations, and an MIBG scan did not reveal metastatic disease. Echocardiogram one month after adrenalectomy showed a marked improvement in LVEF to 55-60% with no regional wall motion abnormalities, and plasma metanephrine concentrations normalized. Case 2 A 61 y/o female smoker with type 2 diabetes mellitus, hypertension, Graves disease and obesity presented with sudden onset of nausea followed by chest discomfort, bilateral shoulder discomfort and shortness of breath. Troponin was 0.6 ng/ml (nl = 0-0.04), EKG showed ST elevations in leads I, 2, V5 V6 with hyperacute T waves. Coronary arteries were normal on catheterization. She required intubation, and systolic BP ranged from 110 to 200 mm Hg. On echocardiogram the LVEF was 35% to 40% (nl = 50-75), and there was diffuse hypokinesis of the mid to apical LV myocardium with hypercontractility of the LV base, suggestive of TC. The plasma metanephrine concentration was 3.31 nmol/l (nl= 0-0.49), and normetanephrine concentration was 5.02 nmol/l (nl= 0-0.89). CT imaging revealed a 2.9 cm left adrenal mass. She underwent successful left adrenalectomy after preparation with alpha, beta blockade and metyrosine. Germline genetic testing was negative for pheochromocytoma/paraganglioma pathogenic gene mutations . Echocardiogram nine months post-adrenalectomy showed normal EF of 50-55% and resolution of apical hypokinesis. Discussion We present two pheochromocytoma patients presenting with TC that reversed following appropriate pheochromocytoma management. Few case series report the association of pheochromocytoma and TC. These patients usually present acutely without prodromal stressors commonly found with classic TC. Conclusion In the setting of TC, pheochromocytoma should be considered. Presentation: Saturday, June 11, 2022 1:00 p.m. - 3:00 p.m.
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Henein, Michael Y., Sergio Vancheri, Giovanni Longo, and Federico Vancheri. "The Impact of Mental Stress on Cardiovascular Health—Part II." Journal of Clinical Medicine 11, no. 15 (July 28, 2022): 4405. http://dx.doi.org/10.3390/jcm11154405.
Повний текст джерелаАнотація:
Endothelial dysfunction is one of the earliest manifestations of atherosclerosis, contributing to its development and progression. Mental stress induces endothelial dysfunction through increased activity of the sympathetic nervous system, release of corticotropin-releasing hormone from the hypothalamus, inhibition of nitric oxide (NO) synthesis by cortisol, and increased levels of pro-inflammatory cytokines. Mental-stress-induced increased output of the sympathetic nervous system and concomitant withdrawal of the parasympathetic inflammatory reflex results in systemic inflammation and activation of a neural–hematopoietic–arterial axis. This includes the brainstem and subcortical regions network, bone marrow activation, release of leukocytes into the circulation and their migration to the arterial wall and atherosclerotic plaques. Low-grade, sterile inflammation is involved in all steps of atherogenesis, from coronary plaque formation to destabilisation and rupture. Increased sympathetic tone may cause arterial smooth-muscle-cell proliferation, resulting in vascular hypertrophy, thus contributing to the development of hypertension. Emotional events also cause instability of cardiac repolarisation due to brain lateralised imbalance of cardiac autonomic nervous stimulation, which may lead to asymmetric repolarisation and arrhythmia. Acute emotional stress can also provoke severe catecholamine release, leading to direct myocyte injury due to calcium overload, known as myocytolysis, coronary microvascular vasoconstriction, and an increase in left ventricular afterload. These changes can trigger a heart failure syndrome mimicking acute myocardial infarction, characterised by transient left ventricular dysfunction and apical ballooning, known as stress (Takotsubo) cardiomyopathy. Women are more prone than men to develop mental-stress-induced myocardial ischemia (MSIMI), probably reflecting gender differences in brain activation patterns during mental stress. Although guidelines on CV prevention recognise psychosocial factors as risk modifiers to improve risk prediction and decision making, the evidence that their assessment and treatment will prevent CAD needs further evaluation.
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Chaumont, Martin, Marc Blaimont, Rachid Briki, Philippe Unger, and Nadia Debbas. "Acute Coronary Syndrome Mimicking Takotsubo Cardiomyopathy or Takotsubo Cardiomyopathy Mimicking Acute Coronary Syndrome?" Case Reports in Cardiology 2020 (February 24, 2020): 1–3. http://dx.doi.org/10.1155/2020/6562316.
Повний текст джерелаАнотація:
A healthy 66-year-old female presented to the emergency department with acute chest pain, T-wave inversion in the anterior leads, and elevated troponin-I. Coronary angiography showed a stenosis in the midportion of the left anterior descending coronary artery (LAD), which did not wrap the left ventricle (LV) apex. LV angiography demonstrated a large LV apical akinetic systolic ballooning with a 45% ejection fraction. Fractional flow reserve (FFR) of LAD lesion was 0.71. Percutaneous intervention was performed. At six months, transthoracic echocardiography was normal. Fifteen months later, the patient presented with chest pain and a small rise in troponin-I. Coronary angiogram was unchanged. Repeat FFR in distal LAD was 0.86 and left ventriculography was normal. Diagnostic criteria for Takotsubo cardiomyopathy (TTC) require the absence of obstructive coronary artery disease. In the present case, TTC was highly suspected on the basis of typical LV apex ballooning. However, significant ischemia in the same territory was demonstrated by positive FFR, which could not be falsely positive in this context. Current TTC diagnostic criteria increase specificity for diagnosing TTC. This case reminds us that it is at the price of reduced sensitivity, since there is no reason to believe that coronary lesions may protect from TTC.
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Sharkey, Scott W., Ankur Kalra, Timothy D. Henry, Timothy D. Smith, Victoria R. Pink, John R. Lesser, Ross F. Garberich, Martin S. Maron, and Barry J. Maron. "Coexistence of acute takotsubo syndrome and acute coronary syndrome." Catheterization and Cardiovascular Interventions 96, no. 4 (November 6, 2019): 825–29. http://dx.doi.org/10.1002/ccd.28595.
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Abdelghany, Mahmoud, Venugopal Brijmohan Bhattad, Charlotte Andersson, Timothy Wymer, and Ashvin N. Pande. "TAKOTSUBO CARDIOMYOPATHY WITH ACUTE CORONARY SYNDROME." Journal of the American College of Cardiology 79, no. 9 (March 2022): 2751. http://dx.doi.org/10.1016/s0735-1097(22)03742-1.
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Madias, John E. "Coronary artery disease/Takotsubo syndrome vs. acute coronary syndromes/Takotsubo syndrome, and their physical/emotional triggers." International Journal of Cardiology 189 (June 2015): 279–80. http://dx.doi.org/10.1016/j.ijcard.2015.04.103.
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Couch, Liam S., Keith Channon, and Thomas Thum. "Molecular Mechanisms of Takotsubo Syndrome." International Journal of Molecular Sciences 23, no. 20 (October 14, 2022): 12262. http://dx.doi.org/10.3390/ijms232012262.
Повний текст джерелаАнотація:
Takotsubo syndrome (TTS) is a severe but reversible acute heart failure syndrome that occurs following high catecholaminergic stress. TTS patients are similar to those with acute coronary syndrome, with chest pain, dyspnoea and ST segment changes on electrocardiogram, but are characterised by apical akinesia of the left ventricle, with basal hyperkinesia in the absence of culprit coronary artery stenosis. The pathophysiology of TTS is not completely understood and there is a paucity of evidence to guide treatment. The mechanisms of TTS are thought to involve catecholaminergic myocardial stunning, microvascular dysfunction, increased inflammation and changes in cardiomyocyte metabolism. Here, we summarise the available literature to focus on the molecular basis for the pathophysiology of TTS to advance the understanding of the condition.
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Feinman, Jason, and Matthew Tomey. "MID-VENTRICULAR TAKOTSUBO CARDIOMYOPATHY MIMICKING ACUTE CORONARY SYNDROME." Journal of the American College of Cardiology 75, no. 11 (March 2020): 2916. http://dx.doi.org/10.1016/s0735-1097(20)33543-9.
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Yaylaci, Serpil, Tuba Cimilli Ozturk, Mustafa Serinken, Cenker Eken, and Ozgur Karcioglu. "Takotsubo Syndrome and Acute Coronary Syndrome: Case Report and Literature Review." Journal of Academic Emergency Medicine 14, no. 1 (February 23, 2015): 41–43. http://dx.doi.org/10.5152/jaem.2015.93446.
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Khovaeva, Ya B., N. V. Kiryanova, T. M. Zinkovskaya, N. V. Ivanova, D. Yu Sosnin, N. P. Moiseenko, E. I. Voronova, S. V. Gladkov, and A. V. Gerasimova. "The case of takotsubo syndrome." Perm Medical Journal 37, no. 6 (January 28, 2021): 123–30. http://dx.doi.org/10.17816/pmj376123-130.
Повний текст джерелаАнотація:
The article describes the current understanding of the takotsubo syndrome concerning the issues of pathogenesis, differential diagnosis with acute coronary syndrome and strategy of management. There is presented our own clinical observation of a patient with an atypical form of cardiac dysfunction and myocardial geometry.
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Ezad, Saad, Michael McGee, and Andrew J. Boyle. "Takotsubo Syndrome Associated with ST Elevation Myocardial Infarction." Case Reports in Cardiology 2019 (May 16, 2019): 1–6. http://dx.doi.org/10.1155/2019/1010243.
Повний текст джерелаАнотація:
Background. Takotsubo syndrome is a reversible heart failure syndrome which often presents with symptoms and ECG changes that mimic an acute myocardial infarction. Obstructive coronary artery disease has traditionally been seen as exclusion criteria for the diagnosis of takotsubo; however, recent reports have called this into question and suggest that the two conditions may coexist. Case Summary. We describe a case of an 83-year-old male presenting with chest pain consistent with acute myocardial infarction. The ECG demonstrated anterior ST elevation with bedside echocardiography showing apical wall motion abnormalities. Cardiac catheterisation found an occluded OM2 branch of the left circumflex artery with ventriculography confirming apical ballooning consistent with takotsubo and not in the vascular territory supplied by the occluded epicardial vessel. Repeat echocardiogram 6 weeks later confirmed resolution of the apical wall motion abnormalities consistent with a diagnosis of takotsubo. Discussion. This case demonstrates the finding of takotsubo syndrome in a male patient with acute myocardial infarction. Traditionally, this would preclude a diagnosis of takotsubo; however, following previous reports of takotsubo in association with coronary artery dissection and acute myocardial infarction in female patients, new diagnostic criteria have been proposed which allow the diagnosis of takotsubo in the presence of obstructive coronary artery disease. This case adds to the growing body of literature that suggests takotsubo can coexist with acute myocardial infarction; however, it remains to be elucidated if it is a consequence or cause of myocardial infarction.
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Schubert, Simone Claire, Angela Kucia, and Anne Hofmeyer. "The Gap In Meeting The Educational And Support Needs Of Women With Takotsubo Syndrome Compared To Women With An Acute Coronary Syndrome." Contemporary Issues in Education Research (CIER) 11, no. 4 (October 5, 2018): 133–44. http://dx.doi.org/10.19030/cier.v11i4.10207.
Повний текст джерелаАнотація:
Background: Takotsubo Syndrome is a condition that causes impairment in cardiac function in the absence of significant causative coronary artery disease. Takotsubo Syndrome is most commonly reported in older women, has identical presenting symptoms to acute coronary syndrome (ACS),but differs in cause, management and outcomes. Ongoing symptoms and recurrence of Takotsubo Syndrome are not uncommon but little support is available for these women.
Aims: This study compares (1) educational support and (2) participation rates in outpatient cardiac rehabilitation for women with Takotsubo Syndrome or acute coronary syndrome, and (3) ascertains whether or not they perceived similar benefits from these strategies.
Methods: 23 women with Takotsubo Syndrome and 23 age-matched women with acute coronary syndrome were mailed a structured questionnaire based on cardiac rehabilitation (CR) components.
Findings: The questionnaire response rate was 48% (n=11) for the Takotsubo Syndrome group and 30% (n=7) for the acute coronary syndrome group. 18% (n=2) of the women with Takotsubo Syndrome and 71% (n=5) of the women with acute coronary syndrome attended cardiac rehabilitation, with all attendees perceiving that it was beneficial in aiding their recovery. Of the nine women with Takotsubo Syndrome that did not attend cardiac rehabilitation, 67% (n=6) perceived that it would have been helpful in aiding their recovery. Women with Takotsubo Syndrome were less likely to receive educational support about their condition, particularly stress management and participate in CR compared with women with ACS, despite perceiving that elements of CR would have been helpful in aiding their recovery.
Conclusions: Women with ACS had higher CR participation rates than those with Takotsubo Syndrome, and were more likely to receive educational support, particularly following hospital discharge. The majority of women with Takotsubo Syndrome were not exposed to educational support in their recovery, suggesting a role for CR tailored to the needs of these women. Nurses can take practical steps to address these gaps by providing emotional support and education for women with Takotsubo Syndrome in stress management to enhance their quality of life and reduce potential recurrence.
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Scudiero, Fernando, Luca Arcari, Luca Cacciotti, Elena De Vito, Rossella Marcucci, Ilaria Passaseo, Luca Rosario Limite, et al. "Prognostic relevance of GRACE risk score in Takotsubo syndrome." European Heart Journal: Acute Cardiovascular Care 9, no. 7 (October 23, 2019): 721–28. http://dx.doi.org/10.1177/2048872619882363.
Повний текст джерелаАнотація:
Background: Takotsubo syndrome is an increasingly recognised cardiac condition that clinically mimics an acute coronary syndrome, but data regarding its prognosis remain controversial. It is currently unknown whether acute coronary syndrome risk scores could effectively be applied to Takotsubo syndrome patients. This study aims to assess whether the Global Registry of Acute Coronary Events (GRACE) score can predict clinical outcome in Takotsubo syndrome and to compare the prognosis with matched acute coronary syndrome patients. Methods: A total of 561 Takotsubo syndrome patients was included in this prospective registry. According to the GRACE score, the population was divided into quartiles. The primary endpoint was all-cause mortality and the secondary endpoints were cardiocerebrovascular events (a composite of all-cause mortality, cardiovascular death, recurrence of Takotsubo syndrome and stroke). Results: The median GRACE risk score was 139±27. Takotsubo syndrome patients with a higher GRACE risk score mostly have a higher rate of physical triggers and lower left ventricular ejection fraction on admission. During long-term follow-up, all-cause mortality rates were 5%, 11%, 12% and 22%, respectively, in the first, second, third and fourth quartile ( P<0.001). After multivariate analysis, the GRACE risk score was found to be a strong predictor of all-cause mortality (odds ratio (OR) 1.68, 95% confidence interval (CI) 1.28–2.20; P=0.001) and cardiocerebrovascular events (OR 1.63, 95% CI 1.26–2.11; P=0.001). Moreover, all-cause mortality in Takotsubo syndrome patients was comparable with the matched acute coronary syndrome cohort. Conclusion: In Takotsubo syndrome, the GRACE risk score allows us to predict all-cause mortality and cardiocerebrovascular events at long-term follow-up.
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Niederseer, David, Jelena Rima Ghadri, Robert Manka, and Christian Templin. "Case report of a 66-year-old woman with atypical takotsubo syndrome and concomitant coronary artery disease." BMJ Case Reports 13, no. 2 (February 2020): e230164. http://dx.doi.org/10.1136/bcr-2019-230164.
Повний текст джерелаАнотація:
Takotsubo syndrome is increasingly recognised worldwide. As both, takotsubo syndrome and acute myocardial infarction can present with similar findings, including chest pain, elevated troponin and creatine kinase, it is often difficult to differentiate these conditions. Here, we present a challenging case that illustrates (1) difficulties to diagnose takotsubo syndrome in the presence of a significant coronary artery stenosis; (2) how takotsubo syndrome could be misdiagnosed as acute coronary syndrome if diagnostic workup does not include echocardiography or left ventriculography; (3) the importance of cardiac MRI which can contribute to the diagnosis of takotsubo syndrome.
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Madias, John E. "Diabetes Mellitus in Patients With Suspected Acute Coronary Syndrome Versus Takotsubo Syndrome." American Journal of Cardiology 117, no. 12 (June 2016): 2001. http://dx.doi.org/10.1016/j.amjcard.2016.04.002.
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Wielgosz, Andreas. "Acute Coronary Syndrome versus Takotsubo Cardiomyopathy: A Diagnostic Dilemma." jcvm 1, no. 1 (January 1, 2019): 1–5. http://dx.doi.org/10.17303/jcvm.2018.4.102.
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Marafioti, Vincenzo, Giulia Turri, and Salvatore Monaco. "Important distinction between acute coronary syndromes and Takotsubo syndrome." Nature Reviews Cardiology 17, no. 4 (January 29, 2020): 258. http://dx.doi.org/10.1038/s41569-020-0342-7.
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Itagane, Masaki, Jun Nakazato, and Mitsuyo Kinjo. "Postpartum pheochromocytoma-induced takotsubo syndrome." BMJ Case Reports 14, no. 3 (March 2021): e240098. http://dx.doi.org/10.1136/bcr-2020-240098.
Повний текст джерелаАнотація:
A postpartum patient with acute-onset dyspnoea and hypotention, associated with reduced left ventricular function requiring intensive blood pressure control, was initially misdiagnosed as having peripartum cardiomyopathy. Her clinical symptoms rapidly resolved. Echocardiography revealed reversible left ventricular dysfunction with apical ballooning and coronary angiography was normal. Based on these findings, we diagnosed takotsubo syndrome. Over the next two months, the patient experienced repeated bouts of elevated sympathetic activity. On workup, we found an adrenal mass and elevated urine metanephrines. After adrenalectomy, histology confirmed pheochromocytoma. Our patient had the rare diagnosis of postpartum pheochromocytoma-induced takotsubo syndrome.
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Sulistya, Inggita Hanung, Anggoro Budi Hartopo, Lucia Kris Dinarti, and Budi Yuli Setianto. "Takotsubo syndrome in elderly woman: The diagnosis by transthoracic echocardiography." SAGE Open Medical Case Reports 7 (January 2019): 2050313X1987892. http://dx.doi.org/10.1177/2050313x19878928.
Повний текст джерелаАнотація:
Takotsubo syndrome has increasingly been recognized in the differential diagnosis of patients presenting with acute chest pain. Those affected are typically older women suffering after an emotional or physical stress. Normally it is a transient condition but complications including death have been reported. We reported a case of takotsubo syndrome who was initially diagnosed as acute coronary syndrome. The patient presented with typical angina, ST-T segment changes, and elevated high sensitive–troponin I. Coronary angiography showed normal coronary arteries. Transthoracic echocardiography revealed mild left atrial dilatation and left ventricle concentric hypertrophy, reduced left ventricle ejection fraction with circumferential hypokinetic, apical ballooning, systolic anterior motion, left ventricle outflow tract obstruction, and sigmoid septum hypertrophy. One month later, patient recovered and transthoracic echocardiography revealed improved heart anatomy and function. To differentiate takotsubo syndrome with other conditions, especially acute coronary syndrome, is crucial. Their clinical presentations are similar but the managements are different. The transthoracic echocardiography holds an important role in supporting the diagnosis of takotsubo syndrome.